Treat-to-target LDL-C strategy noninferior to high-intensity statin in coronary artery disease

A treat-to-target low-density lipoprotein cholesterol (LDL-C) strategy of 50–70 mg/dL appears to be comparable to a high-intensity statin therapy in terms of preventing major adverse cardiac and cerebrovascular events in patients with coronary artery disease, according to a study.

The study was conducted across 12 centres in South Korea. A total of 4,400 patients were randomly assigned to undergo either the LDL-C target strategy (LDL-C level between 50 and 70 mg/dL as the target; n=2,200) or high-intensity statin treatment (rosuvastatin 20 mg or atorvastatin 40 mg; n=2,200). The primary study endpoint was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization.

Of the patients, 4,341 (98.7 percent) completed the trial. Their mean age was 65.1 years, and 1,228 (27.9 percent) were women. Before randomization, 25 percent and 57 percent of patients were taking a high-intensity statin and a moderate-intensity statin, respectively. 

Over 6,449 person-years of follow-up, the primary endpoint occurred in 177 patients in the treat-to-target group and 190 in the high-intensity statin therapy group (8.1 percent vs 8.7 percent; absolute difference, −0.6 percentage points; p<0.001 for noninferiority).

At week 6, the mean LDL-C level was significantly higher in the treat-to-target group than the high-intensity statin therapy group (69.6 vs 66.8 mg/dL; difference, 2.8 mg/dL, 95 percent confidence interval [CI], 1.3–4.3; p<0.001), but this difference disappeared after 6 weeks.

The mean LDL-C level during the overall study period was 69.1 mg/dL in the treat-to-target group and 68.4 mg/dL in the high-intensity statin therapy group, with the difference not reaching significance (p=0.21).

The present data provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy.